Family Presence during Cardiopulmonary Resuscitation

TLDR

Family presence during cardiopulmonary resuscitation (CPR) has been debated for its impact on relatives and clinicians, prompting a study of 570 relatives across 15 prehospital emergency units. The study randomized 15 EMS units to either systematically offer family members the opportunity to observe CPR (intervention) or to follow standard practice (control), with the primary endpoint being the proportion of relatives exhibiting PTSD‑related symptoms at 90 days and secondary endpoints including anxiety, depression, resuscitation effort, team well‑being, and medicolegal claims. Results showed that relatives who witnessed CPR had significantly lower rates of PTSD (adjusted OR 1.7, 95 % CI 1.2–2.5), anxiety, and depression, while family presence did not alter resuscitation characteristics, patient survival, team stress, or medicolegal outcomes, indicating a psychological benefit without compromising care. The trial was funded by the French Ministry of Health Programme Hospitalier de Recherche Clinique 2008 and registered at ClinicalTrials.gov (NCT01009606).

Abstract

The effect of family presence during cardiopulmonary resuscitation (CPR) on the family members themselves and the medical team remains controversial.We enrolled 570 relatives of patients who were in cardiac arrest and were given CPR by 15 prehospital emergency medical service units. The units were randomly assigned either to systematically offer the family member the opportunity to observe CPR (intervention group) or to follow standard practice regarding family presence (control group). The primary end point was the proportion of relatives with post-traumatic stress disorder (PTSD)-related symptoms on day 90. Secondary end points included the presence of anxiety and depression symptoms and the effect of family presence on medical efforts at resuscitation, the well-being of the health care team, and the occurrence of medicolegal claims.In the intervention group, 211 of 266 relatives (79%) witnessed CPR, as compared with 131 of 304 relatives (43%) in the control group. In the intention-to-treat analysis, the frequency of PTSD-related symptoms was significantly higher in the control group than in the intervention group (adjusted odds ratio, 1.7; 95% confidence interval [CI], 1.2 to 2.5; P=0.004) and among family members who did not witness CPR than among those who did (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P=0.02). Relatives who did not witness CPR had symptoms of anxiety and depression more frequently than those who did witness CPR. Family-witnessed CPR did not affect resuscitation characteristics, patient survival, or the level of emotional stress in the medical team and did not result in medicolegal claims.Family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts. (Funded by Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health; ClinicalTrials.gov number, NCT01009606.).